A study last year found that more than 40% of doctors feel "frustrated" by obese patients. But feelings among doctors are not the only problem. Recent studies have found that a woman who is as little as 13 pounds overweight may receive less than optimal medical care. Women who are over 20 pounds on the wrong side of the scale are more prone to inaccurate diagnoses, have more trouble finding a fertility doctor for help with getting pregnant, and are less likely to receive early diagnosis and effective treatment for cancer.

She links to a January CNN article on the risks of misdiagnosis for overweight women, which may be higher than for women of lower BMI. One reason for this is that body fat can mask tumors and other problems — but another may be simple prejudice. Dr. Jerome Groopman tells CNN, "If doctors have negative feelings toward patients, they're more dismissive, they're less patient, and it can cloud their judgment, making them prone to diagnostic errors." He adds,

It's called attribution, because your thinking is colored by a stereotype and you attribute the entire clinical picture to that stereo­type. Because obesity can cause so many health problems, it's very easy to blame a variety of complaints, from knee pain to breathing troubles, on a patient's weight. That's why doctors — and patients — need to constantly ask, 'What else could this be?'

But how can patients ask this question? Greenberg doesn't really address what recourse overweight patients have, segueing instead into a critique of "today's overwhelming guidelines about what is required of all of us to stay healthy." But when patients depend so much on doctors, we need to learn how to determine if they're worthy of our trust.

Unfortunately, the common suggestion that patients educate themselves has limited usefulness. Yes, patients should know their rights and have a basic understanding of good health and any conditions they're dealing with. But as a longtime hypochondriac, I've learned the dangers of getting my medical information from the Internet. Doctors often complain about patients who demand tests or medications they read about in some questionable source, and it's true that a little research is no substitute for years of medical training. Licensed physicians usually do know more about medicine than we do, and at some point we all need to rely on one. So perhaps the solution is to make them more reliable.

One way patients can take control is learning to spot bias, and health plans should give patients enough choice in doctors that they can find one who's sensitive to their concerns. For some women, this means a doctor who knows weight loss isn't a miracle cure. For others, it may mean someone who doesn't hound them about their declining fertility. And for others still, it may mean a doctor who's willing to help with fertility issues without being judgmental about weight (according to CNN, overweight women have more difficulty getting fertility treatment). But medical schools can help too, by teaching would-be doctors to look beyond body size and give patients the best care possible, regardless of weight. Maybe it's a pipe dream to hope that one day doctors are all trained in Health At Every Size principles, but at the very least they could be taught about the dangers of weight bias, and about treating overweight patients with the same care and attention they'd devote to anyone else. Doctors often talk about the health risks of obesity — but they need to make sure they're reducing those risks, not adding to them.